1126 GRAND AVE 2020-03-06 - Laserfiche WebLink

E PERMIT APPLICATIO is BUILDING/ MECHANICAL/ PLUMBING /SIGN INKLER/ DEMOLITION E V E R E T TCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Bwe (r ack Ink Only Please)' ..:....PROJEC SI1 E4NFORMATIO .:W:I . ,O PROJECT SITE ADDRESS: 1 I Z 41'viii j(.J0 ri kr e"--- PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) a z i r s OWNER NAME: 0(9/14= 3) LV t L(\7 4NANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: STREET 112 Co !.OA&JO /44-.4. CITY r /4eY-. STATE ZIP OWNER PHONE: .-0,57-• icrO ':-.2 .1.--SIC OWNER EMAIL: CONTRACTOR NAME: 7 Z4 — ,(jri✓. Aug-4 S I r ei) J L L u CONTRACTOR ADDRESS: STREET/V 0 e 0,01„,i&iLCill (_ . ( ) 0 /9t-1wi--t-'E ITY STATE 414' ZIP Sore Z) CONTRACTOR PHONE: 'J b fa'-` Y �On`r7 J � CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): J',`1 aQ C 3 U CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ' - PRIMARY CONTACT: ►. NER 0 CONTRACTOR 0 OTHER(Please Specify) r r�-J! CONTACT NAME: CONTACT PHONE: '7 7.,s-- yJ O 7r�1 a 0&./. CONTACT EMAIL: Existing Use of Building: S 2- Contract Price of Work:$ j 2 0 Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse El Duplex ❑ADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel GI Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: 3-'0 (to udixs �,r+Ar i..,'-Z.,2 . ]• NI i eri/ -(aa/f�r LAKE- 1Z-9-a, L0I(. @-1/404, E` t 0),)0 ki ASSOCIATED BUILDING PERMIT#(if applicable): . .I IECHANIC.AL PERM T APPLIC.4:1 1.0P .',. P: PLUJMB.iN',�r,_PERMIT APPLICATION ,...< . x:... Fixture r Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) f Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater 't:. '3,-.,,sr:RINKLERkSUPPREASION,SySTP ,M_ Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads. ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. 2--) q. City of Everett Official Use Only ff""Z"----------- -_ 1 . I PER o \l— O�� Owner/Authorized Agent Signature Date (Revised 4/15/2019)